Tox: Toxidromes, DDx by presentation

Question 1

Anticholinergic toxidrome

Answer 1

‘Mad as a hatter, dry as a bone, red as a beet, hot as a hare, blind as a bat’

Aka: delirium, DRY, flushed skin, hyperthermia. mydriasis.

Also:
Urinary retention, seizures.

Question 2

features differentiating sympathomimetic from anticholinergic toxidrome

Answer 2

Anticholinergic = DRY (also, less HTN, tachycardia). 
Sympatho = WET, ++diaphoresis (more HTN, tachy)

Question 3

Cholinergic toxidrome

Answer 3

SLUDGE: salivation, lacrimation, urination, defecation, GI cramping, emesis.

Killer Bs: bronchospasm, bradycardia, bronchorrhea

Question 4

Sympathomimetic toxidrome

Answer 4

Agitation, diaphoresis, hallucinations, HTN, hyperthermia, tachycardia, mydriasis, muscular rigidity

Question 5

Opioid toxidrome

Answer 5

CNS depression, bradycardia, hypothermia, miosis, resp depression

Question 6

DDx for sympathomimetic toxidrome/presentation

Answer 6

Withdrawal (alcohol, benzos), serotonin syndrome, NMS, non-tox (thyrotoxicosis, etc), stimulant use

Question 7

Tox DDx coma

Answer 7

alcohols, antipsychotics, antiseizure meds, CO, CN, muscle relaxants, opioids, sedative/hypnotics

Question 8

Tox DDx delirium

Answer 8

Anticholinergics/cholinergics, muscle relaxants, NMS, serotonin syndrome, sympathomimetics, withdrawal syndromes

Question 9

Tox DDx seizure

Answer 9

Antidepressants (TCAs, bupropion), anticholinergics, cholinergics, isoniazis, local anesthetics, mushrooms, sympathomimetics, toxic alcohols, wtihdrawal syndromes

Question 10

Tox DDx hepatic injury

Answer 10

Tylenol, ethanol, iron, mushrooms (amanita phalloides)

Question 11

Tox DDx renal injury

Answer 11

Ethylene glycol, heavy metal salts (mercury), mushrooms (cortinarius orellanus), rhabdo (cocaine, amphetamines)